Current Issues in Clinical Psychology Chapter 3 By: Farrah J. Cordero

By: Farrah J. Cordero

Models of Training in Clinical Psychology The Scientist-Practitioner The Training Model/ AKA Boulder Model Integrates Science and Clinical Practice Idea: Practitioners who can produce as well as consume research Debate: Psychologists split in two groups Clinical Practice & Research Resulted in the Psy.D. degree By: Farrah J. Cordero

Models of Training in Clinical Psychology The Doctor of Psychology (Psy.D.) Degree Model Emphasis on Development of Clinical Skills De-emphasis on Research Masters Thesis Not Required Dissertation- a Report on a Professional Topic instead of an Original Research Idea Ph.D. and Psy.D. programs similar until 3rd year Third year- experience in therapeutic practice and assessment becomes the focus Fourth Year- clinical emphasis continues with internship assignments By: Farrah J. Cordero

Models of Training in Clinical Psychology Professional Schools No affiliation with universities Autonomous w/ own financial and organizational frameworks Faculty chiefly clinical in orientation Employed only as part-time w/ major employment elsewhere Emphasis is on clinical not research orientations Accreditation by the APA nice but not necessary Award over ½ of the doctorates Admittance is higher compared to traditional university-based program By: Farrah J. Cordero

Models of Training in Clinical Psychology Clinical Scientist Model Empirically Oriented Clinicians feel clinical psychology is not well grounded in Science Research either has not been completed/ does not support the therapy techniques Resulted in the Academy of Psychological Clinical Science Focuses graduate training to produce “Clinical Scientists” Persons who think and function as scientists in every respect & setting Academy affiliated with American Psychological Society (APS) Over 50 member programs By: Farrah J. Cordero

Clinical Scientist Model cont. Primary Goals Training geared to careers in clinical science research Advancing full range of clinical science research & theory and integrating that w/other sciences Foster timely dissemination of clinical science to policy makers, psychologists, consumers, etc. Development of and access to resources & opportunities for training, research, funding, & Clinical science careers Application of clinical science to human problems By: Farrah J. Cordero

Models of Training in Clinical Psychology Combined Professional-Scientific Training Programs Combined Specialties (Counseling, Clinical, & School Psychology) Assumption is: these specialties share common core areas of knowledge The practices of psychologists who graduate from these specialties are similar Curriculum focuses on core areas w/i psychology Exposes students to each subspecialty of Counseling, Clinical, and School Psychology By: Farrah J. Cordero

Models of Training in Clinical Psychology Graduate Programs: Past & Future Mid-1960’s shift from university-based academic jobs to jobs in private practice occurred 1973 Vail Training Conference resulted in endorsements of Alternative Training Models Psy.D. degree and Professional School Model of Training traced back to positions held by those attending the Vail Conference Possible Trends that May Effect the Training Models Some feel there may be oversupply of Practice-oriented Psychologists By: Farrah J. Cordero

Graduate Programs: Past & Future cont. Possible Trends that May Affect the Training Models Some feel there may be oversupply of Practice-oriented Psychologists Managed Health Care likely to affect the demand for Clinical Psychologists in the future as well as the Curriculum in Training Programs There may be an Undersupply of Academic and Research-Oriented Clinical Psychologists By: Farrah J. Cordero

Professional Regulation Attempted to Protect the Public Interest by Developing Standards of Competence CERTIFICATION Weak Form of Regulation Does not prevent persons from offering counseling as long as “Psychologist” title is not used nor term used to describe services Can not call oneself Psychologists unless they have been certified by a state board of examiners Involves an Exam consisting of review of training and professional experience By: Farrah J. Cordero

Professional Regulation LICENSING Stronger Form of Legislation than Certification Describes & Defines Title , Training Required, and Specific Activities that are Offered to Public APA developed a Model for the Licensure of Psychologists Licensing Laws vary from State to State/Province to Province but there are several commonalities (pg. 65, Table 3-1 Summary of Requirements) Includes an Exam Board examines the applicant’s educational background and sometimes requires several years of supervised experience beyond doctorate Subsequent Continuing Education Requirements By: Farrah J. Cordero

By: Farrah J. Cordero

Professional Regulation American Board of Professional Psychology (ABPP) Offers Certification of Professional Competence in the following Fields: Behavioral, Clinical, Clinical Health, Clinical Neuropsycholgoy, Counseling, Family, Forensic, Group, Psychoanalysis, Rehabilitation, and School Psychology Candidates must have 5 years Postdoctoral Experience National Register Type of Self-certification Include those who are Licensed/Certified in their own states Individuals submit their name and Pay to be listed By: Farrah J. Cordero

Private Practice Independence & Economics Psychiatric Profession opposed, early on, clinicians from going into private practice Eventually won the right to practice Independently Psychiatrists accepted the new legal status accorded to clinicians At this time more Health Insurance Plans became Operative People who normally could not afford therapy were now covered By: Farrah J. Cordero

Private Practice cont. Independence & Economics Direct reimbursement of Psychologists by Insurance Companies without a physician’s involvement became an issue As a result of a Antitrust Action brought against a health insurance company the victorious outcome signified Psychologists as a fully independent profession able to compete in the marketplace alongside Psychiatry By: Farrah J. Cordero

Private Practice The Health Care Revolution “Managed Health Care is an Integrated Approach to financing and delivery of health care” By end of 1997, 85% of Americans belonged to some kind of managed health care Several Models of Managed Care, all attempt to control costs and reduce use of services while at the same time ensuring their quality…i.e. HMO/PPO By: Farrah J. Cordero

Private Practice cont. The Health Care Revolution New systems dictate new definitions of what constitutes psychological treatment Clients will be seen for a fewer number of sessions/ & greater number of clients will be seen per year Treatment will be Brief and intermittent Therapist will serve as a catalyst for clients to make changes in their lives Most changes will occur outside of treatment By: Farrah J. Cordero

Private Practice cont. The Health Care Revolution Treatment will not be terminated rather interrupted after client’s progress evident Community Resources will be used to a greater extent Most treatment delivered in a group format & will involve structured psychoeducational programs Master’s-level practitioners and paraprofessionals much cheaper for same services By: Farrah J. Cordero

Private Practice cont. The Health Care Revolution Scientist-practitioner/Clinical Scientist training offers some opportunities in managed healthcare Have an empirical orientation that emphasizes the study of outcomes Have skills different from those of physicians Can bring an emphasis on preventing mental health problems in individuals and focus on wellness rather than sickness Know about the effects of the environment on behavior By: Farrah J. Cordero

Prescription Privileges Controversial issue Decision will have far-reaching implications for the role definition of clinical psychologists, their training, and actual practice Pros Enable psychologists to provide wider variety of treatments and treat wider range of clients Potential increase in efficiency and cost-effectiveness of care for patients needing both therapy and meds Give psychologists a competitive advantage in health care By: Farrah J. Cordero

Prescription Privileges cont. Cons May lead to de-emphasis of “psychological” forms of treatment because meds are faster acting and more profitable than psychotherapy May damage clinical psychology’s relationship with psychiatry and general medicine Conflicts resulting in lawsuits Increased Malpractice liability costs Financial burden of modifying training programs and licensing laws By: Farrah J. Cordero

Culturally Sensitive Mental Health Services APA (2003) published guidelines on multicultural education, training, research, practice, and organizational change for psychologists Make commitment to cultural awareness as well as knowledge of self & others as cultural beings Recognize the importance of multicultural sensitivity Integrate multiculturalism & diversity into education and training Recognize importance of culture in research and clinical work By: Farrah J. Cordero

Culturally Sensitive Mental Health Services cont. S. Sue (1998) has advocated that psychologists demonstrate cultural competence: Scientific-mindedness: Clinicians must formulate and test hypothesis regarding status of clients Dynamic sizing: Must be skilled in knowing “when to generalize and be inclusive and when to individualize and be exclusive” Culture-specific expertise: Understand their own culture and perspectives, have knowledge of the cultural groups with whom they work By: Farrah J. Cordero

Ethical Standards Competence Training must be represented accurately Present themselves correctly/regard to training and all other aspects of competence Should not attempt treatment/assessment procedures for which you lack specific training/supervised experience Be sensitive to treatment/assessment issues that could be influenced by pts’ gender, ethnicity, age, sexual orientation, religion, disability, or socioeconomic status By: Farrah J. Cordero

Ethical Standards cont. Privacy & Confidentiality Central to client-psychologist relationship Be clear and open about matters of confidentiality and the conditions under which it could be breached 1976 Tarasoff Case Each state has different standards By: Farrah J. Cordero

Ethical Standards cont. Human Relations/ Client Welfare Sexual activities, Employing a client, selling a product to a client, or even becoming friends with a client after termination of therapy can lead to exploitation of and harm to client By: Farrah J. Cordero

By: Farrah J. Cordero